Case Report / Olgu Sunumu DOI:10.4274/tnd.2021.56313 Generalized Myasthenia Gravis Diagnosed After Blepharoplasty Blefaroplasti Sonrası Tanı Alan Jeneralize Miyastenia Gravis Short title: Myasthenia Gravis in Differential Diagnosis of Ptozis Kısa başlık: Pitoz Ayırıcı Tanısında Miyastenia Gravis Murat Alemdar, Mustafa Karabacak Sakarya University, Faculty of Medicine, Department of Neurology, Adapazarı, Sakarya Corresponding Author Information Murat Alemdar dr.alemdar@gmail.com 905322032744 https://orcid.org/0000-0001-7127-3119 03.05.2020 16.05.2021 Abstract Neuromuscular junction disorders should not be missed in the differential diagnosis of ptosis. A 69-year-old male patient was admitted to our clinic with droopy upper eyelids, prominent in the left side for 6 months. Attributing his eyelid skin sag to aging, blepharoplasty was performed 5 months ago. He was referred to our department after no benefit from operation. He reported difficulty in walking and climbing stairs, and getting fatigued while chewing food. In repetitive nerve stimulation studies, a significant decremental response was observed in the compound muscle action potential amplitudes recorded from the nasalis muscle with sequential stimulation of the facial nerve on both sides, and the trapezius muscle with the stimulation of the left accessory nerve. His serum acetylcholine receptor antibody level was elevated (40.7 nmol / L). Myasthenia gravis was diagnosed, and pyridostigmine therapy was recommended. He described a clear improvement in his complaints ten days later on control visit. The history of this late-diagnosed case presenting with ptosis emphasizes the importance of questioning additional findings like diplopia, chewing-swallowing difficulties, weakness in proximal muscles, and whether there is an increase in those complaints with fatigue. Keyword: Blepharoptosis, myasthenia gravis, blepharoplasty Özet Pitozun ayırıcı tanısında nöromusküler kavşak hastalıkları atlanılmamalıdır. Polikliniğimize 69 yaşında bir erkek hasta, 6 aydır olan sol göz kapağında daha belirgin olmak üzere göz kapaklarında düşüklük nedeniyle başvurdu. Kapak derisinin uncorrected proof